INTO THE HOME STRETCH: PRE-MAINTENANCE
For those of you who began Atkins in Induction or Ongoing Weight Loss (OWL), the end is in sight. (Of course, you know that "the end" is really only the beginning of your new lifestyle.) If your goal was to slim down, it's within your grasp. If you were determined to lower your blood pressure and your blood sugar and insulin levels or improve your cholesterol and triglyceride levels, your indicators should show marked improvement. Just for fun, flip back through some of the entries in your diet journal to remind yourself of how far you've come in the last several months (or weeks, if your objectives were small). Your achievements are the result of keeping your eye on the big picture, feeding your body in a way that minimizes temptation, and not letting minor setbacks derail you.
Let's put one issue to rest. Many people don't understand why Atkins is made up of four phases instead of three. Once you reach your goal, you're done, right? Wrong! Difficult as losing weight is, it pales in comparison to the challenge of maintaining your healthy new weight. Almost anyone can stick with any diet for weeks—or even months. But permanently changing your way of eating is much more difficult. That's why Phase 3, Pre-Maintenance, and Phase 4, Lifetime Maintenance, are distinct. In Phase 3, you'll attain your goal weight and then make sure that you can stay right there for a month. (Some people remain in Ongoing Weight Loss, or OWL, until they reach their goal weight, as discussed in the last chapter.) This dress rehearsal prepares you for the real show, the rest of your life in Lifetime Maintenance. Regard Pre-Maintenance as the beginning of your transition to a permanent and sustainable way of eating.
Whether the Carbohydrate Level for Losing (CLL) that you found in OWL is 30 or 80 grams of Net Carbs, you've obviously hit upon a mix of nutrients that works for you, at least for weight loss. Give yourself a round of applause as you begin to whittle away those last few pounds and inches and normalize your health indicators.
...Phase 3, in which many of you will have the opportunity to test the waters with the remaining carbohydrate food groups. These include fruits other than berries, starchy vegetables, and whole grains. Which is not to say that you have to eat these foods or even that you can eat them.
You'll explore your tolerances for foods higher on the carb ladder as you increase your overall carb intake (generally in 10-gram increments) until you reach and maintain your goal weight for a month. Although this seems like a relatively small goal, particularly if you've already trimmed a substantial amount of extra weight, the last few pounds and inches are often the most stubborn to let go, particularly if you try to advance your carb intake too quickly. This phase could take as long as three months or even more, but that's fine. Now is the time to think like a tortoise, not like a hare. But first, time for a reality check.
In addition to saying good-bye to those final 10 pounds of excess fat, you want to identify your overall tolerance for carbohydrates, as well as which foods you can and cannot handle. In this phase you'll fine-tune those two concepts. Hard as it may be at this crucial time, keep your focus on the process, which will naturally lead to your desired results. If you rush to shed those last pesky pounds, you may never learn what you need to know to keep them off for good.
If you're feeling deprived and looking forward to revisiting all your old food friends as soon as possible, you're cruising for a bruising. Unless you're blessed with superhuman powers of self-control or the metabolism of a superhero—in which case we doubt you'd be reading this book —it's simply unrealistic to think you can drop weight and/or get your blood sugar, blood pressure, and lipids under control and then return to your old way of eating without repercussions. In fact, no matter how you lose weight, abandoning your new way of eating once you reach your goal almost inevitably leads to weight regain. If you return to a high-carb diet—usually laden with heavily processed foods—you'll also likely experience the attendant health problems we've already mentioned... Pre-Maintenance trains you for a lifetime way of eating.
You may have lost pounds, only to gain some of them back. If you've followed the program to the letter and found that certain foods reawakened cravings, you may have moved beyond your Carbohydrate Level for Losing (CLL). Or you may have progressed too quickly. As you now know, both can reawaken the sleeping metabolic bully. Frustrating as these experiences have surely been, the silver lining is that they've given you valuable information on what you can and cannot eat. Knowledge is power. Even if you don't like everything you've learned, your hard-earned education about your body's response to carbohydrates will allow you to work within its comfort range—and put you, not that box of cookies or slice of pizza, in control.
You may have found that reintroducing certain foods stalled your weight loss or actually made you regain a few pounds. Perhaps you became reacquainted with some of the old familiar demons: cravings, out-of-control appetite, and midafternoon fatigue. Maybe you felt that you'd jumped back on that blood sugar roller coaster. Like it or not, it may be that your body is particularly sensitive to carbohydrates and you'll have to continue to keep your intake low to avoid regaining weight and experiencing other harmful metabolic effects. You may need to heal your metabolism by continuing at a relatively low-carb level for the foreseeable future.
BEGINNING IN PRE-MAINTENANCE
If you're starting out with 10 to 20 pounds to lose or are presently happy with your weight and are changing your diet for health reasons, you may start in this phase at 40 grams of Net Carbs a day, increasing by 10-gram weekly increments until you approach your Atkins Carbohydrate Equilibrium (ACE), discussed below. If weight is not your issue, you'll know that you've exceeded your ACE when you develop cravings or unreasonable hunger, your energy level drops, or your health indicators stop improving or revert to previous levels.
{In this paragraph above is the suggestion that those folks who are already skinny should start at the 40 grams of carbs a day. Obviously, if you have cravings or unreasonable hunger, or lack of energy, you will want to drop the carb level. But if those things are not a problem, and you are generally skinny, you should try the 40 grams of carbs but get it with added things like carrots or sweet potatoes.}
WHAT TO EXPECT IN PRE-MAINTENANCE
As you increase your carb intake and home in on your goal weight, you may lose an average of as little as a half pound a week, which is perfectly natural. All the while, you'll be learning the eating habits that will guide you for the rest of your life. As in OWL, you'll experiment as you figure out what you can and can't eat. This process of testing your limits or even temporarily backing off—using your weight change as the imperfect indicator you now know it is—is all part of the learning curve.
There's a good likelihood that at some point you'll find yourself on a plateau. If you experienced one or more of the inexplicable cessations of weight loss in OWL, you'll know what to do. If you haven't plateaued before, go back to "Hitting a Plateau" on page 128 and carefully reread that section. Dealing patiently with and learning from a plateau is essential to your continued success. (If you seem to be getting nowhere despite following these suggestions, it's likely that you've happened upon your ACE prematurely and need to drop back 10 to 20 grams of Net Carbs to continue losing.) After all, your ultimate success in Lifetime Maintenance is achieving a permanent plateau—aka your goal weight. You may get discouraged and be tempted to revert to OWL (or even Induction) to banish those last pesky pounds ASAP. Don't do it! Pre-Maintenance is where you learn how to eat in the real world of family dinners, business lunches, holiday gatherings, vacations, and myriad other occasions in which food plays a major role.
THE BASICS OF PRE-MAINTENANCE
Now that you're in Phase 3, you'll still follow pretty much the same drill you have until now to stay in a fat-burning mode. You must know it by heart by now: count your carbs, and be sure that 12 to 15 grams of your total daily Net Carb intake is made up of foundation vegetables. They'll continue to be the platform upon which you build as you add back new carbohydrate foods. Also, keep eating the recommended amounts of protein and sufficient natural fats to feel satisfied at the end of each meal. Continue to drink plenty of water and other acceptable beverages, consume enough salt, broth, or soy sauce (unless you take diuretics) if your Net Carb intake is 50 grams or less, and take your supplements.
So what's different? You'll slowly increase your daily Net Carb intake in 10-gram increments as long as weight loss continues and follow the Pre-Maintenance meal plans in part III. In effect, you're swapping the pace of your weight loss for a slightly higher CLL. But if this brings your weight loss to a grinding halt or you gain back a pound or so that remains longer than a week, simply drop back 10 grams. Stay there for a couple of weeks, and if slight weight loss resumes, try increasing your carb intake by 5 grams to see if you get the same reaction you did with a 10-gram increase. You may wind up remaining at the same CLL that you were at in OWL, even as you reintroduce some of the acceptable foods for this phase. Once you exceed 50 grams of Net Carbs, you need not continue to consume salty broth, soy sauce, or a half teaspoon of salt each day.
{I'm skipping the part about adding back in dairy and legumes for their "fiber" content.}
OTHER FRUITS
Assuming you didn't have trouble reintroducing moderate portions of berries, cherries, and melon in OWL, you can now experiment with other fruits. As you'll see below, carb counts vary significantly. Remember that all fruit is high in sugar and should be treated as a garnish. Start by introducing portions of no more than a half cup of such relatively low-carb fresh fruits as plums, peaches, apples, tangerines, and kiwis. One small ripe banana, on the other hand, packs about 21 grams of Net Carbs and its close relative, the plantain, even more. Avoid canned fruit. Even fruit packed in juice concentrate or "lite" syrup is swimming in added sugar.
Continue to stay away from fruit juice, other than lemon and lime juice. A cup of unsweetened apple juice, for example, racks up 29 grams of Net Carbs, and orange juice (even freshly squeezed) is a close runner-up. Without the fiber to slow its absorption, fruit juice hits your metabolism like a sledgehammer. Likewise, drying fruit, including apricots, raisins, prunes, and apple slices, concentrates the sugars, elevating their carb count.
STARCHY VEGETABLES
Vegetables such as winter squash, sweet potatoes, and root vegetables such as carrots, beets, and parsnips have their virtues. All root vegetables are rich in minerals, and brightly colored ones are full of antioxidants. But the flip side is that these same vegetables are significantly higher in carbs than foundation vegetables are. You'll want to keep your portions of these starchy vegetables small unless you have a very high tolerance for carbs. Even within this grouping, carb counts vary greatly. Carrots and beets, for example, come in well below corn on the cob and potatoes. And a single serving of cassava exceeds the total carb intake for a day in Induction, with taro a close runner-up.
WHOLE GRAINS
This is usually the last food group to reintroduce (if at all), and with good reason. Ounce for ounce, grains are generally the highest in carb content of any whole food. You'll note that we refer to this category as whole grains, not simply grains. Oats, buckwheat, brown rice, and other whole grains are good sources of fiber, B vitamins, vitamin E, and minerals such as zinc and magnesium. But they and products made with them—whole grain bread, for one—come with a high-carb price tag. Even for people with a relatively high ACE, these foods could bait the metabolic bully. Introduce them with care and if tolerated, consume them in moderation.
PROCEED WITH CAUTION
Refined grains and processed foods made with them are a very different story. Their high carb count is accompanied by scant nutritional value. As much as possible, continue to stay away from refined grains such as white flour and bread and crackers made from them. Refined grains, including white rice, have been stripped of their valuable bran and germ (the seed embryo, which is rich in antioxidants, fatty acids, and other micro-nutrients).
You'll note that the list of Acceptable Foods for Pre-Maintenance doesn't list processed foods such as bread, pasta, pita breads, tortillas, crackers, breakfast cereals, and the like, as carb counts vary significantly from one manufacturer to another. While you should continue to check the Nutritional Facts panel on all processed products, foods that incorporate grains particularly qualify as minefields. In addition to avoiding foods with trans fats and added sugar, watch out for white or "enriched" flour. Baked goods made with whole wheat or other whole grains—look for 100 percent whole grain—tend to be higher in fiber and thus lower in carbs, as well as higher in micronutrients. If white flour is the first item on the ingredients list, followed by whole grain flour, forget about it.
{Ya'll know our position on gluten containing grains; I've just included the above so ya'll see that even these guys are real wary of grains at all.}
WHAT DOES PRE-MAINTENANCE LOOK LIKE?
As before, you'll add the acceptable new foods gradually, one group at a time as long as you can handle them, and one food at a time within each group. It's important to continue to record in your journal how you respond to each new food because you're now entering territory full of foods that may have triggered cravings and possibly binges in the past. So let's look at three scenarios of how your first several weeks of Pre- Maintenance might go.
SCENARIO 1
Say that you've left OWL with a CLL of 50.
• Week 1 : You move up to 60 grams of Net Carbs a day, sampling a few different kinds of legumes over the week, during which you lose another pound.
• Week 2 : You move to 70 grams of Net Carbs and reintroduce small portions of new fruits. You lose no weight and struggle with cravings for more fruit.
• Week 3 : You drop back down to 60 grams of Net Carbs and continue with small portions of fruit, being sure to have them with cream, yogurt, or cheese. The cravings diminish, and you lose half a pound over the week.
{Bad using dairy to anesthetize the cravings!}
• Week 4 : You remain at 60 grams of Net Carbs and reintroduce small portions of carrots, sweet potatoes, and green peas on alternate days. You lose another pound by week's end.
• Week 5: You move to 70 grams of Net Carbs and cautiously introduce tiny portions of whole grains every other day, shedding a half pound by week's end.
• Week 6 : You move to 80 grams of Net Carbs and continue to carefully try different fruits, legumes, starchy vegetables, and occasionally whole grains. By the end of the week, you've lost another half pound.
SCENARIO 2
Again assume you had a CLL of 50 upon leaving OWL.
• Week 1 : You move up to 60 grams of Net Carbs a day. You couldn't care less if you ever eat another legume again, but you sample a few different kinds of fruit over the week. Your weight is unchanged at week's end.
• Week 2: You remain at 60 grams of Net Carbs and find yourself craving more fruit, so you make sure to always combine it with cheese, cream, or yogurt, and you manage to lose a half pound.
• Week 3 : You move to 65 grams of Net Carbs and reintroduce small portions of carrots, sweet potatoes, and sweet peas on alternate days. By week's end, you've regained a pound.
• Week 4 : You drop back to 55 grams of Net Carbs and continue to cautiously consume both fruit and some starchy vegetables. Although you don't regain weight, you don't lose any either.
• Week 5: You move up to 60 grams of Net Carbs but back off the starchy vegetables. By the end of the week, you've lost half a pound and wonder whether you're getting pretty close to your ACE.
• Week 6: You continue at this carb level and hold off on the starchy vegetables, losing half a pound that week.
SCENARIO 3
Now let's assume that you left OWL with a CLL of 35.
• Week 1 : You move to 45 grams of Net Carbs, adding small portions of legumes. Although your weight remains stable, by the end of the week, you've had some ravenous episodes and feel bloated.
• Week 2 : You drop back to 35 grams of Net Carbs and back off the legumes. Your weight loss resumes, and the bloating and cravings disappear.
• Week 3: You're feeling good and slowly losing weight, so you decide not to push your luck and remain at 35 grams of Net Carbs for another week.
• Week 4: You move up to 40 grams of Net Carbs and try reintroducing small legume portions. You continue to feel good and lose another half pound.
• Week 5: You move up to 45 grams of Net Carbs and add small amounts of fruit, which produce cravings and stall weight loss.
• Week 6 : Understanding that feeling good and in control is more important than trying to push things, you back down to 40 grams of Net Carbs, experimenting with new foods in small portions, until you've achieved your goal weight.
As you can see, there is a tremendous variation in how individuals respond to increases in carb intake and to different foods. Your own scenario will undoubtedly differ. Also remember that your weight can vary by a few pounds from day to day, independent of increments in carb intake and different foods. That's why it's important to continue to use the weight-averaging method described on page 77.
YOUR CARB TOLERANCE
Like it or not, you may find that there are some foods you simply cannot handle or must eat very carefully in order to not regain weight and stimulate cravings. Likewise, if elevated blood sugar or metabolic syndrome has been an issue for you, it's likely that you'll need to be very careful about introducing higher-carb foods. (For more on metabolic syndrome, see chapter 13.) Knowing your limits will enable you to have a realistic approach to meal planning once you're in Lifetime Maintenance. Anxious as you may be to reach your goal weight, achieving it in a way that's close to the way that you'll be eating to sustain that new weight makes it more likely you'll succeed long term.
Once you've achieved your goal weight but before you move to Lifetime Maintenance, you'll have to find your Atkins Carbohydrate Equilibrium (ACE). In contrast to your CLL, which relates to weight loss, your ACE is the number of grams of Net Carbs you can eat each day, while neither losing nor gaining weight. Many people wind up with an ACE of 65 to 100 grams of Net Carbs, but some people have a considerably lower ACE and a very few people an even higher one.
It's important to understand that looking merely at weight loss can oversimplify the issue of carb tolerance. Your energy level, ability to concentrate, tendency to retain fluid, and, of course, the old signals of unreasonable hunger and carb cravings must also be considered.
For example, even if you're losing weight at a CLL of say, 50 grams of Net Carbs a day, you might still be reawakening food cravings or blood sugar swings or experiencing low energy, which could make maintaining that level of carb intake problematic long term. Why are we bringing this up? Because some people, for a variety of reasons, find that they do best at 25 to 50 grams of Net Carbs in either the weight loss or weight maintenance phases. Your objective is not to push your carb intake to the absolute limit but to advance to the point where you're comfortable and don't stimulate the return of any of the old symptoms that originally got you into trouble. Bottom line: finding your ACE is not just a matter of getting to the right weight; if you're pushing your ACE too high, it is probably not sustainable.
What's unique about the low-carb way of eating compared to other diets is that adhering first to your CLL and later your ACE results in profound changes in your metabolism, enabling you to better control your intake of calories. The flip side is that if you exceed your ACE, you're forcing your body to burn more glucose while inhibiting fat breakdown and utilization. This makes it harder to control appetite and feel satiated, with the result that you'll almost certainly regain lost pounds. You'll lose the Atkins Edge and the metabolic bully will rear its ugly head again, blocking fat burning.
GETTING (THE FAT) UP THERE
From everything we've told you so far, you'd think that it's the carbs in your diet that stop weight loss at your goal. That's partially true, because carbs do exert a strong control over your metabolism—the bully thing. But when you move from losing weight to maintaining weight, you need to increase your consumption of healthy, natural fats slightly to meet your maintenance energy needs. No, you don't need to measure or count your intake of fatty foods. With your appetite as your guide, you just need to let it happen. We'll tell you how in the next chapter. All you need to know for now is that as you approach your goal weight, you may become aware of something that hunting peoples have known about for centuries: "fat hunger." It's a different and subtler feeling than having the bottom drop out on you after a sugar rush. But if you find yourself staring into the fridge and eyeing the butter, cheese, or salad dressing, you've probably been skimping on fat. Learning to recognize and respond appropriately to fat hunger is an important skill for success in Lifetime Maintenance.
